Provider Demographics
NPI:1144655903
Name:HUGH CHATHAM MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:HUGH CHATHAM MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-527-7463
Mailing Address - Street 1:180 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2430
Mailing Address - Country:US
Mailing Address - Phone:336-527-7463
Mailing Address - Fax:
Practice Address - Street 1:5229 ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:NC
Practice Address - Zip Code:28635-9267
Practice Address - Country:US
Practice Address - Phone:336-696-2711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty